Introduction to Basic Concepts

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Introduction to Basic Concepts

• Population Health

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Population Health
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• Overall goals of population health approach
• Maintain improve health of entire population
• Reduce inequities in health between population
  groups

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• Population health approach can be
• 1. A conceptual framework for thinking about
  health
• 2. A framework for taking action

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• The model includes
• 1. Multiple client levels
• Affirms approaches that conceptualize aggregates
  and whole populations as legitimate targets of
  health promotion initiatives

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• 2. Determinants of health
• Confirm the increasing weight of evidence that
  factors outside health care system affect health
• Began with Lalonde A New Perspective on the
  Health of Canadians
• Many other determinants of health now identified

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• Health Canada Model Determinants of Health
• Income social status
• Social support networks
• Education
• Employment working conditions

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• Physical environment
• Biology genetic endowment
• Personal health practices coping skills
• Healthy child development
• Health services

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• Winnipeg Regional Health Authority Population
  Health Assessment Framework
• Determinants of health
• Social environment
• Gender
• Culture
• Health services

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• Healthy child development
• Personal health practices coping skills
• Biology genetic endowment
• Physical environment
• Employment working condition
• Education
• Social support network
• Income social status

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• Toronto Charter (Raphael et al, 2004)
• Social determinants of health
• Early childhood development
• Education
• Employment working conditions
• Food security
• Health care services

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• Housing
• Income its equitable distribution
• Social exclusion
• Canadian women
• Aboriginal people
• Canadians of colour
• New Canadians

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• Social safety nets
• Unemployment job insecurity

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• 3. Action strategies
• Outline the ways action can be taken to improve
  health
• Strengthen community action
• Build healthy public policy
• Create supportive environments
• Develop personal skills
• Re-orient health services

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• 4. Values assumptions
• Health care organizations
• Act on health determinants within their
  jurisdiction
• Influence other sectors to ensure their policies
  have positive impact on health

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• Individual health is a result of
• Personal health practices
• Physical social environments
• Optimal health depends on ability to meet
  physical, mental, social spiritual needs
• Social justice
• Mutual respect caring

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• Health care, health protection disease
  prevention complement health promotion
• Need strategic mix of all
• People require meaningful participation in
  development implementation of policies
  programs that affect their health

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Planning Using the PHP Model

• Overall goals of population health approach
• Maintain improve health of entire population
• Reduce inequities in health between population
  groups

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A Closer Look at Two Determinants of Health

• 1. Income Social Services
• The evidence
• In 1996, poverty rate in Canada had risen to
  17.9
• Child poverty rate reached 21
• Increasing gap between rich poor
• (Raphael, 1999)

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Canadas Low-Income Cut-Offs (LICOs) - 2002
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(No Transcript)
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• In Manitoba, in 2002, 31 of workers earned low
  wages
• 4.1 earned minimum wage

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• Less than 1 in 5 minimum wage earners are young
  adults living at home
• 1/3 are the only wage earner in their family
• 2/3 are adults
• 60 are women
• 23 work full time

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• If minimum wage had kept pace with inflation,
  would now be more than 9.25/hr
• If working minimum wage, 1 adult with 2 children
  would have to work 85 hours a week to reach the
  LICO (poverty line)

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• Fastest growing segment of population using food
  banks in MB are people who have jobs (Social
  Planning Council of MB, 2003)
• Links between poverty health well established
• Poverty also associated with provision of fewer
  services (Raphael, 1999)

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• Economic disadvantage has many forms
• Fewer assets
• Poorer education
• Insecure employment
• Hazardous or dead-end job
• Poor housing
• Inadequate retirement pensions

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• These disadvantages tend to concentrate amongst
  the same people
• Their effects accumulate over a lifetime (WHO,
  2003)

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• Implications for Intervention
• Safety nets not enough
• Need springboards at critical life transitions to
  offset earlier disadvantage

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• Interventions should
• Narrow gap between rich poor
• Enable all citizens to participate in social,
  economic, cultural life
• Provide economic security for all
• Provide equity for all (SK Health, 1999)

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• 2. Social Support Networks
• Concept of social capital (Health Canada, 2003)
• Networks, norms social trust that facilitate
  coordination cooperation for mutual benefit
  (Putnam, 1995, p. 670)

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• Presence of neighbourhood groups creates
  horizontal interactions that benefit the
  community
• Discourage potentially destructive
  individualistic/opportunistic actions
• Create reciprocal relationships
• Facilitate communication trust
• Promote survival of communitys heritage

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• The Evidence
• Communities with substantial social capital have
  better economic social performance
• Lower crime rates
• More tolerance
• Children do better in school
• May mitigate effects of sub-optimal economic
  circumstances

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• Overhead with diagram from Upperman Gauthier,
  1998

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• Implications for Intervention (SK Health, 1999)
• Create a sense of belonging
• Create opportunities to both give receive help
• Create mutually supportive relationships
• Create respect for those different from self
• Constructive conflict resolution

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PHP vs. Health PromotionContinuities
Divergences
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Community Health Nursing
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History of the Practice

• Important to understand origins of community
  health nursing
• What lessons can you drawn from the reading by
  McKay?

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Roles Standards of Practice

• Covered in detail in Chapter 4 of text
• Many forms of nursing are included under the
  general category of community health nurse
• public health nurse
• home health (home care) nurse
• community health centre/outreach nurse
• outpost/rural nurse

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• parish nurse
• occupational health nurse
• Some of these practices require specific
  certification

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• Definitions of public health nursing
• Canadian Public Health Association
• An art science
• Synthesizes public health nursing knowledge
• Goal to promote and preserve health of
  populations

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• American Public Health Association
• Directed to community or populations
• Concerned with environmental, social personal
  factors affecting health
• Targets resources to those at greatest risk

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• 4 client levels
• -individual
• -family
• -group
• -community
• At all 3 levels, ultimate goal is to change the
  health status of the community

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• Canadian standards of practice
• Promoting health
• Building individual/community capacity
• Building relationships
• Facilitating access equity
• Demonstrating professional responsibility
  accountability

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• Practice settings
• official public health agency
• clients home
• schools
• streets
• community health centres
• outposts
• churches
• worksites

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• Roles
• direct care provider advocate
• educator enabler
• supervisor/manager mediator
• researcher/evaluator facilitator
• disaster responder catalyst

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Disaster Nursing

• Three phases of a disaster
• Disaster preparedness
• The disaster
• Disaster recovery

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• Emergency management has 5 levels
• 1) the individual organization
• 2) local responders
• -fire, police, health care system
• 3) provincial response
• -usually under auspices of EMO

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• 4) national response
• -generated from appropriate federal agency
• 5) international response
• -WHO
• -UN
• this one isnt in the reading

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• Roles in disaster situations are unpredictable
• Some aspects of the experience, however, are
  predictable
• -more about that in the epidemiology class

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• Fundamental nursing responsibilities
• -promote health
• -prevent illness
• -restore health
• -alleviate suffering

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Future Trends/Challenges In Community Health
Nursing

• Greater theoretical underpinnings for the role
• More focus on health promotion
• More at-risk populations
• Increased community assessment for real
  potential health risks
• More complex patterns of client referral

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• More diversity in sites where services provided
• More capacity to respond to disasters other
  global threats to health
• Increase in communicable disease control
• Greater emphasis on culturally appropriate care